Healthcare Provider Details

I. General information

NPI: 1538991773
Provider Name (Legal Business Name): DISHA JAYESH PATEL GC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST WHITNEY HENDRICKSON BLDG STE 134
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

13512 BONITA ISLAND WAY
TEXAS CITY TX
77568-2113
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-2650
  • Fax: 859-323-0702
Mailing address:
  • Phone: 614-404-5496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberTCG056
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: